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Wound Dehiscence

(Surgical Wound Dehiscence; Operative Wound Dehiscence)

Definition

Wound dehiscence is the parting of the layers of a surgical wound. Either the surface layers separate or the whole wound splits open. This is a serious condition and requires care from your doctor.

Causes    TOP

Wound dehiscence varies depending on the kind of surgery you have. The following is a list of generalized causes:

  • Infection at the wound
  • Pressure on sutures
  • Sutures too tight
  • Injury to the wound area
  • Weak tissue or muscle at the wound area
  • Incorrect suture technique used to close operative area
  • Poor closure technique at the time of surgery
  • Use of high-dose or long-term corticosteroids
  • Severe vitamin C deficiency ( scurvy)

Wound Infection

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Risk Factors    TOP

The following factors increase your chance of developing wound dehiscence.

  • Overweight
  • Increasing age
  • Poor nutrition
  • Diabetes
  • Smoking
  • Malignant growth
  • Presence of prior scar or radiation at the incision site
  • Non-compliance with post-operative instructions (such as early excessive exercise or lifting heavy objects)
  • Surgical error
  • Increased pressure within the abdomen due to: fluid accumulation (ascites); inflamed bowel; severe coughing, straining, or vomiting
  • Long-term use of corticosteroid medications
  • Other medical conditions, such as diabetes, kidney disease, cancer, immune problems, chemotherapy, or radiation therapy

Symptoms    TOP

If you experience one or more of these symptoms in the surgical area, contact your doctor.

  • Bleeding
  • Pain
  • Swelling
  • Redness
  • Fever
  • Broken sutures
  • Open wound

Diagnosis    TOP

Your doctor will ask about your symptoms and examine the surgical area. Tests may include the following:

  • Laboratory tests, such as:
    • Wound and tissue cultures to determine if there is an infection
    • Blood tests to determine if there is an infection
  • Imaging studies, such as:
    • X-ray —to evaluate the extent of wound separation
    • Ultrasound —to evaluate for pus and pockets of fluid
    • CT scan —to evaluate for pus and pockets of fluid

Treatment    TOP

  • Drug therapy
    • Antibiotic therapy
  • Medical treatment
    • When appropriate, frequent changes in wound dressing to prevent infection
    • When appropriate, wound exposure to air to accelerate healing and prevent infection, and allow growth of new tissue from below
  • Surgical intervention
    • Surgical removal of contaminated, dead tissue
    • Resuturing
    • Placement of a temporary or permanent piece of mesh to bridge the gap in the wound

If you are diagnosed with wound dehiscence, follow your doctor's instructions.

Prevention    TOP

  • When appropriate, have antibiotic therapy prior to surgery.
  • When appropriate, have antibiotic therapy after surgery.
  • When using wound dressing, maintain light pressure on wound.
  • Keep wound area clean.
  • Comply with post-operative instructions.

RESOURCES:

American Academy of Family Physicians
http://www.aafp.org/online/en/home.html
American College of Surgeons
http://www.facs.org

CANADIAN RESOURCES:

Canadian Association of Wound Care
http://www.cawc.net
The Canadian Society of Plastic Surgeons
http://www.plasticsurgery.ca

References:

Bennett R. Fundamentals of Cutaneous Surgery . St. Louis, MO: CV Mosby; 1988: 498.
DeCherney AH, Nathan L. Current Obstetric & Gynecologic Diagnosis & Treatment . 9th ed. New York, NY: McGraw-Hill; 2003.
Dorland WN. Dorland's Illustrated Medical Dictionary . Philadelphia, PA: WB Saunders, Harcourt Health Sciences; 2005.
Porter RS. The Merck Manual of Medical Information Home Edition . 2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2004.
Schwartz S, Brunicardi F, et al. Schwartz’s Principles of Surgery . 8th ed. New York, NY: McGraw-Hill; 2007.
Last reviewed September 2013 by Marcin Chwistek, MD
Last Updated: 9/30/2013
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